This descriptive article examines the potential for student-led initiatives in international health to be better integrated with formal medical education systems. Students have embraced the challenges and opportunities provided by globalisation to take a leadership role on international issues. Medical students are involved with a diverse portfolio of international activities, including work to internationalise the medical curriculum, the establishment of “hands-on” development projects, efforts to promote student exchanges, and engagement with high-level international policy fora. Such experiences not only add to the personal and professional development of the individual student, but also have the potential to contribute to the academic environment of the host institution as well as more broadly influencing the determinants of international health outcomes. There are challenges and risks associated with independent student initiatives, however these risks can be mitigated if institutions work in partnership with their students and peers internationally.